RESIDENT EXPERIENCES OF PERSON-CENTRED CARE AT MEALTIMES IN LONG-TERM RESIDENTIAL CARE: A RAPID ETHNOGRAPHY

Abstract Poor nutrition is a common ongoing problem in long-term residential care, often resulting in reduced quality of life. Previous research has concluded that the content of the meal, dining environment, service style and general atmosphere all add to the mealtime experience, suggesting that person-centred mealtimes are optimal. However, knowledge about which elements of person-centred care can be achieved in a mealtime setting in a given context is currently lacking. As part of the TRANS-SENIOR research network, rapid ethnographies were conducted across multiple sites (including interviews, observations and informal conversations), in long-term residential care homes in the UK, Switzerland and the Netherlands between October 2020 and December 2021. During analysis and interpretation of data, different themes were developed where either successfully achieved or missed opportunities for person-centred moments were observed. We observed differences between the long-term care homes in as much as the setting could be considered, resident choice was implemented, residents were enabled, care was individualized in the communal setting and how much the person of the residents was known with their past and present. In the presentation we will discuss the possibility to provide person-centred care during mealtimes in view of differences between staff approaches, the overall environment (size of dining area, seating arrangements etc.), allocation of staff resources and country-specific rules and regulations. We see an interplay of factors in place for mealtimes to be moments of participatory choice, interaction, independence, and dignity.

The Moving Forward Coalition established a health information technology (HIT) committee to develop action plans to advance the adoption of HIT in all nursing facilities.Currently, more than 70% of nursing facilities in the US have some HIT, although the levels of utilization vary greatly.Few facilities, however, have successfully implemented the capabilities required to survive in a Value Based Payment (VBP) model which Medicare will mandate by 2030.Fewer still have HIT that collects the resident's goals, preferences, and priorities (GPPs) efficiently and in detail despite current CMS requirements for person-centered care.To the best of our knowledge, no nursing facilities possess an HIT-enabled capability to determine whether the care provided aligns with the individual's GPPs.In this presentation, members of the HIT Committee of the Moving Forward Coalition will discuss the rationale for adopting the following three HIT priorities to realize the target goals of the Coalition and will review progress made to date: 1) develop a benchmarking tool that enables nursing facilities to understand and plan for the HIT capabilities needed to meet upcoming regulatory requirements and for successful participation in a VBP model, 2) create a taxonomy of GPPs and an HIT-based process to collect them, and 3) develop and test an HIT-enabled process to measure the concordance of care provided with an individual's GPPs.Although the Moving Forward Coalition and the NASEM report focus on nursing facilities, the HIT tools being developed here will benefit all sites of care.

MEASURING AND IMPLEMENTING PERSON-CENTERED LONG-TERM CARE: GLOBAL PERSPECTIVES
Chair: Tonya Roberts Co-Chair: Franziska Zuniga Discussant: Michael Lepore Person-centered care (PCC) is internationally recognized as an essential strategy for achieving high quality care and quality of life for older adults who need long-term care (LTC).Despite international endorsement, our understanding of PCC is largely derived from research and practice in western countries.It is less clear whether PCC practices and benefits are generalizable on a global scale.PCC may vary structurally across healthcare contexts and cultures where values, experiences, and needs of older adults differ.Understanding how to culturally adapt or extend the concept, measurement, and implementation of PCC is needed to better inform care and improve outcomes for a diverse and international population of older adults.The purpose of this symposium is to present theory and research across healthcare settings and from countries across multiple continents to comparatively analyze the cultural implications of PCC concepts and discuss the implications for implementation, measurement, and research.The first presentation will contextualize the concept of PCC from an international perspective, summarizing and comparing what is known about PCC from existing literature.The second presentation will compare barriers and facilitators of PCC implementation during mealtimes in three European countries.The third will highlight variations in PCC definitions from qualitative research conducted with providers in middle-and low-income countries.The fourth presentation will report on the development and implementation of a system of PCC and LTC in Brazil.The final presentation will use secondary data to compare the measurement and LTC needs of family caregivers across the US and China.This is a Common Data Elements for International Research in Residential Long-term Care Interest Group Sponsored Symposium.

PERSON-CENTERED CARE: SETTING THE INTERNATIONAL SCENE FROM A CONCEPTUAL PERSPECTIVE
Tonya Roberts 1 , and Annica Backman 2 , 1. University of Wisconsin, Madison, Wisconsin, United States, 2. Umea University, Umea, Vasterbottens Lan, Sweden Over 142 million older persons worldwide need assistance with meeting basic needs, often requiring some level of long-term support and services.Person-centered care (PCC) is internationally recognized as an essential strategy for achieving high quality care and quality of life for older adults who need long-term care.Rather than focusing only on disease management or preventing morbidity, PCC results in positive outcomes for older people and their caregivers by focusing care on the whole person in their unique environment and aligning care with what is holistically meaningful to older people.Although PCC has become the gold standard for care of older adults, its widespread implementation has led to theoretical, conceptual, and practical inconsistencies that make it challenging to compare or evaluate its application or effectiveness globally.This is particularly problematic given our understanding of PCC is largely derived from research and practice in western cultures.Despite positive outcomes, the wide spectrum of person-centered interventions introduces variation which has made global comparisons difficult and ability to identify needs for cultural adaptation largely absent.To be able to compare PCC internationally, and reflect on potential needs for cultural adaptation, more conceptual clarity of the concept of PCC, its measurement, and implementation is needed.The purpose of this presentation is to review the use, value, and implementation of PCC concepts in international literature and present possible future directions for extending PCC to be more culturally inclusive for a global older adult population.

RESIDENT EXPERIENCES OF PERSON-CENTRED CARE AT MEALTIMES IN LONG-TERM RESIDENTIAL CARE: A RAPID ETHNOGRAPHY
Megan Davies 1 , Franziska Zuniga 2 , Hilde Verbeek 3 , and Sandra Staudacher 4 , 1. Medical Faculty, University of Basel,Basel,Switzerland,2. University of Basel,Basel,Switzerland,3. Maastricht University,Maastricht,Limburg,Netherlands,4. Universität Basel,Basel,Switzerland Poor nutrition is a common ongoing problem in long-term residential care, often resulting in reduced quality of life.Previous research has concluded that the content of the meal, dining environment, service style and general atmosphere all add to the mealtime experience, suggesting that person-centred mealtimes are optimal.However, knowledge about which elements of person-centred care can be achieved in a mealtime setting in a given context is currently lacking.As part of the TRANS-SENIOR research network, rapid ethnographies were conducted across multiple sites (including interviews, observations and informal conversations), in long-term residential care homes in the UK, Switzerland and the Netherlands between October 2020 and December 2021.During analysis and interpretation of data, different themes were developed where either successfully achieved or missed opportunities for person-centred moments were observed.We observed differences between the long-term care homes in as much as the setting could be considered, resident choice was implemented, residents were enabled, care was individualized in the communal setting and how much the person of the residents was known with their past and present.In the presentation we will discuss the possibility to provide person-centred care during mealtimes in view of differences between staff approaches, the overall environment (size of dining area, seating arrangements etc.), allocation of staff resources and country-specific rules and regulations.We see an interplay of factors in place for mealtimes to be moments of participatory choice, interaction, independence, and dignity.

MEASURING AND IMPLEMENTING PERSON-CENTERED, RESIDENTIAL LONG-TERM CARE: BRAZILIAN CONTEXT
Patrick Wachholz 1 , Michael Lepore 2 , and Franziska Zuniga 3 , 1. Faculdade de Medicina de Botucatu -Universidade Estadual Paulista (Unesp), Botucatu,Sao Paulo,Brazil,2. University of Maryland School of Nursing,Baltimore,Maryland,United States,3. University of Basel,Basel,Switzerland Older adults represent most users in the Brazilian Unified Health System (SUS), which provides at least one service to 57.7% of the national older population.Despite Brazilian legislation ensuring the rights of older adults, health inequities are evident, including barriers to access prevention services, weaknesses and inequities in the distribution of human resources trained to meet the needs of older adults, and several vulnerabilities to the social determinants of health that undermine healthy aging prospects.Family members provide most care, and informal caregivers are neither paid nor receive financial support.The proportion of older adults living with disability has grown significantly over the last decade, and approximately two-thirds of the care-dependent population in Brazil are adults over 65 years of age.Institutional long-term care (LTC) represents a growing part of the Brazilian older population, but several factors challenge the implementation of person-centered care (PCC) in residential LTC.Although 73% of Brazilian families are covered by primary care provided at SUS, only 56.3% of older people in Brazil are registered in the Family Health Strategy, and most people living in LTC facilities do not have access to primary care.The purpose of this presentation is to contextualize how the dissemination and implementation of a PCC culture and the definition of a national conceptual perspective are affected by the immaturity of the Brazilian LTC sector, the lack of coordinated long-term care policies, and ageism in the healthcare sector.

UNDERSTANDING PERSON-CENTERED CARE FOR OLDER PEOPLE IN SIX DEVELOPING COUNTRIES
Jing Wang 1 , and Barbara Bowers 2 , 1. University of New Hampshire, Durham, New Hampshire, United States, 2. University of Wisconsin-madison, Madison, Wisconsin, United States Person-centered care (PCC) is a widely acknowledged and encouraged approach to quality care for older adults residing in residential care facilities.However, current understandings of PCC are mainly based on research and practice in western, first world nations.The lack of research on PCC in developing countries leads to uncertainty over whether and how current understandings of PCC apply to cultures and contexts in non-western, developing countries.To enhance care and outcomes for diverse populations, it is crucial to comprehend and culturally adapt PCC understandings and approaches.Therefore, we conducted interviews with researchers and practitioners from six countries in various stages of development to identify elements that form the core of high-quality care for older people and how they relate to Western notions of PCC.We gained valuable insights into how cultural differences, population health priorities, political conflict, and limited resources impact their understanding and implementation of PCC.In addition to variations in the language of PCC, some first world assumptions about PCC do not resonate well in developing countries.One example is the emphasis on individualism, a basic element of PCC.The role of the older person in decision making and focus on family and community priorities reflects both cultural and economic differences between first world, western nations and non-western, developing countries.The findings can serve as a valuable starting point for the development of a globally applicable measurement for the quality of care.

ASSESSING CAREGIVING SUPPORT NETWORKS FOR PERSONS WITH DEMENTIA IN A LONG-TERM CARE CONTEXT IN CHINA AND THE US
Hanzhang Xu 1 , Matthew Dupre 1 , Scott Lynch 1 , Truls Østbye 2 , and Bei Wu 3 , 1. Duke University, Durham, North Carolina, United States, 2. Duke University School of Medicine,Durham,North Carolina,United States,3. New York University,New York City,New York,United States Informal caregivers are vital to the provision of care for persons living with dementia (PLWD).Although PLWD often receive care from multiple sources, little is known about the broad caregiving support networks that PLWD have.Furthermore, the structure of caregiving support networks is likely influenced by the availability, accessibility, and affordability of LTC services.Therefore, caregiving support networks in China and in the U.S. are likely to differ.In this study, we identified the major types of caregiving support networks that PLWD have using the Health and Retirement Study and China Health and Retirement Longitudinal Study.Results from latent class analysis show that both countries